Hypertensive retinopathy as the initial presentation of neuroblastoma

Abstract

PurposeTo describe a case of a patient who presented with hypertensive retinopathy and was found to have neuroblastoma.ObservationsNeuroblastoma has three main ocular presentations. As a primary disease, it can present with a paraneoplastic syndrome in the form of opsoclonus, or it can present as a Horner's syndrome from its effect on the cervical sympathetic ganglia. Metastatic disease can present as a triad of periorbital edema, ecchymosis and proptosis from orbital bone involvement. Hypertension is a rare systemic presentation of neuroblastoma. We report the case of a two-year-old girl whose initial presentation of neuroblastoma was hypertensive retinopathy.Conclusions and importanceTo our knowledge, this is the first reported case of neuroblastoma presenting as hypertensive retinopathy. Our case highlights the importance of a multidisciplinary approach and thorough systemic work up of ocular findings in order to arrive at an appropriate diagnosis.

Ophthalmologic Manifestations of Neuroblastoma: A Systemic Review

“…The association between the mean age of the Neuroblastoma patients and ophthalmologic manifestation according to our analysis of 65 case reports and Musarella et al8–10,12–14,16–18,21–37,44–73 HS indicates Horner syndrome; OMS, opsoclonus-myoclonus syndrome. *Statistical significance.…”

“…To avoid magnetic resonance imaging or computed tomography, the physician could firstly assess the urine catecholamine level; however, the sensibility of this parameter is limited (varies from 60.71% in our case reports analysis to 71%91). As NBL is connected with an elevated catecholamine production, it may result in higher blood pressure;48,61 thus, increasing the hypertensive retinopathy risk 69…”

“…As NBL is connected with an elevated catecholamine production, it may result in higher blood pressure; 48,61 thus, increasing the hypertensive retinopathy risk. 69 Among the malignancies causing the orbital metastases in children, NBL is second most common only to leukemia in terms of incidence. 92 The most common malignancies affecting the orbit in children are reticulum-cell sarcoma arising from dendritic cells, 93 leukemia, and NBL.…”

“…The incidence of the primary tumor localization in patients diagnosed with neuroblastoma, ganglioneuroblastoma, and ganglioneuroma according to the 84 analyzed case reports 9,10,12–14,16–18,21–31,33–39,44–53,55–62,64–66,68–79,81–84. AM indicates adrenal medulla; GN, ganglioneuroma; GNBL, ganglioneuroblastoma; NBL, neuroblastoma.…”

“…The incidence of opsoclonus-myoclonus syndrome and the associated symptoms in 68 children diagnosed with neuroblastoma, and 16 patients with ganglioneuroblastoma. Overall, there were 29 cases of opsoclonus-myoclonus syndrome 9,10,12–14,16–18,21–39,44–80. OMS indicates opsoclonus-myoclonus syndrome.…”